Establish etiology.
Review patient history and wound management.
Perform leg examination.

Vascular consult

Arterial complications?

Yes

No

End

Necrotic tissue
Removal of necrotic tissue:

Autolytic debridement
Sharp debridement
Enzymatic debridement

Fibrotic tissue
Small amounts: Leave intact.
Moderate to large amcunts:

Autolytic debridement
Sharp debridement
Enzymatic debridement

Debridement?

Yes

No

Yes

Dressing management based on amount of wound drainage

Alginate/hydrofiber dressings
Hydrogel dressings
Foam dressings
Cellular tissue products
Drugs (fibrinolytic agents or pentoxifylline [Trental])

Systemic
Treatment:

Outpatient oral or I.V. antibiotics
In patient I.V. antibiotics
No occlusive management modalities

Localized
Treatment: Dressing management Use an antimicrobial dressing based on amount of drainage from hydrdogel, alginate/hydrofber, or foam category Cadexomer iodine gel or pads

Infection?

Yes

No

Yes

Stockings
Inelastic compression system (Unna's boot)
Elastic compression system (multilayer sustained graduated compression system)
Pumps

Compression management?

Yes

Reevaluation

No

Infection
Weeping dermatitis
Arterial disease
Heart failure

Consult physician

Choose appropriate management modalities